I have read with great interest the editorial, titled “The Uniqueness of Osteopathic Medicine: Do We Know What it is?” in the Winter 1994 issue of the Joumal. In the concluding paragraph, readers were invited to send in our “…ideas about what makes osteopathic medicine different.” I accept this invitation.

As is reflected in my “prolific” (your word) writings, I have long felt that the profession’s emphasis on its “distinctiveness” and “uniqueness” as justification for its “… existence as a separate profession in the world of medicine” is unfortunate. I find no value in being different just for the sake of being different. What matters is what is accomplished with the difference.

To paraphrase statements made in my 1990 article that you cite1, the unanswered question that continues to confront the osteopathic medical profession is: “What enhancements of human health and welfare do your alleged distinctions enable you to contribute, and what persistent and prevalent health-related problems can you solve that cannot be accomplished by any other profession in the world of medicine”? That is the awaited and ultimate distinction!

In that same article (and others), I sought to demonstrate that the profession is being presented with historic opportunity to meet increasingly urgent health needs, brought by ongoing demographic and other changes in our society, for which the profession is uniquely prepared by the philosophy — the strategy-that avowedly guides osteopathic practice. That guiding philosophy is precisely what is required at this stage of our epidemiological history- well into the next century, Those needs are not being met by the prevailing strategies despite the impressive and even valuable advances in technology and by the endless succession of “breakthroughs”.

What is that osteopathic philosophy? Let me paraphrase again:

One: The recognition of the following:

a) the unity of body and person; that each part’s functional quality affects and is affected by the competence of all other body parts;

b) that the competence of the body parts is influenced by the entire history of the person, beginning with conception, and by the unique and continually changing constellations of circumstances, factors and influences in each individual’s life;

c) and, therefore, that true health care must be of the person by modification of such major factors as are subject to modification, in directions that favor the recovery and enhancement of health. This is to be distinguished from disease care largely or solely directed at the bodily components and processes that have been victimized by those factors and circumstances, important as that may be. “To find health should be the object of the doctor.” Anyone can find disease. (A. T. Still)

Two: a) Recognition of, and total dependence on each person’s indwelling “health care system; that it is not only a system” that defends and heals but is a real “health maintenance organization.”

b) Awareness that, given a favorable balance of health-affecting factors in each person’s life, it is the ultimate source of health and of the recovery of health; that health and healing come from within. Health cannot be transfused like blood or transplanted like a kidney.

c) Acknowledgment, therefore, that the highest function of the physician is to give support to the competence of each patient’ s indwelling healthcare system, to remove impediments to its function and to teach patients to do the same for themselves.

d) Among the most common impediments are the musculoskeletal dysfunctions that are the traditional focus of osteopathic practice. Unlike most other impediments and deleterious factors (such as habits, customs, environments, behaviors, economic status, diets, abuse of body and mind, etc.) somatic dysfunctions readily subject to favorable modification by appropriate skills.

Three: Recognition of the following about the human musculoskeletal system:

a) It is the most massive system in the body, placing the greatest demand upon other systems for energy and maintenance.

b) It is the ultimate instrument of human behavior, through which one acts out ones’ humanity and individuality and is profoundly affected by the overall quality of each person’s total behavior.

c) The human musculoskeletal system is, because of its upright conformation, uniquely vulnerable to gravitational and other external forces.

d) Being richly innervated and vascularized, the musculoskeletal system is in continuous and intimate communication with all other parts of the body. Its impairments and dysfunctions inexorably affect other cells, tissues and organs and their impairments are reflected in components of the musculoskeletal system.

Four: Research has richly documented that such musculoskeletal dysfunctions exaggerate the impact of other detrimental, and often less modifiable, factors in the person’ s life. Through neural connections their collective impact is directed to other tissues and organs, including components of the homeostatic, defensive, health-maintaining and health-restoring systems.

The longer the musculoskeletal dysfunction exists, the greater the toll taken on the competence of the affected body parts and, therefore, on the individual’s health. Osteopathic manipulative treatment, therefore, has enormous health-enhancing and preventive as well as therapeutic value.

For these reasons, osteopathic manual medicine is a central and strategic component in the implementation of the osteopathic philosophy discussed above. It is of special and unique value at this stage of our demographic and epidemiological history, in which, as the proportion of aged in the population continues to increase, so has (and will) the predominance of the chronic, largely incurable, irreversible degenerative diseases which require costly, long-term “hightech” care.

It is becoming increasingly evident that these afflictions are not inherent aspects of the aging process. (Aging itself is not a pathological process!) They are the products of the progressively larger tolls taken even by seemingly inconsequential factors, circumstances and impediments the longer one lives. In short, these diseases are largely preventable. Widespread implementation of the whole-person approach that characterizes the osteopathic philosophy is the required strategy.

Unfortunately, the osteopathic medical profession is so deeply absorbed in being mainstream, that it seems to have forgotten that it came into existence to lead the way upstream — to fundamental medical reform. It is not yet too late to return to the mission. But it will require that the profession’s resources and its educational system be aimed at the dominant health needs of the nation. It short, it may require that the profession become a focused profession, rather than a diffusely “complete” one.